CNN reports that "more than one medical professional is under scrutiny as a possible person of interest as Louisiana's attorney general investigates whether hospital workers resorted to euthanasia in the chaotic days after Hurricane Katrina shattered New Orleans." The investigation centers on Memorial Hospital:

CNN has learned the investigation is looking at the possibility that medical personnel at the hospital were afraid of anarchy in the city, feared they could be the next targets of violence as they grew increasingly tired of horrible conditions inside the hospital.

Memorial Hospital had been a storm refuge for up to 2,000 people. Patients, staff and their families rode out the storm inside. But by Thursday, four days after Katrina hit, despair was setting in. The hospital was surrounded by floodwater. There was no power, no water and stifling heat. Food was running low. Nurses were forced to fan patients by hand. And outside the hospital windows, nurses tell CNN they saw looters breaking into a credit union.

There's a fascinating first-page story in today's Wall Street Journal (paid subscription required -- the Chinese aren't the only ones who believe in "pay as you go"!) that describes the structural and operational features of the Chinese health care system. [tm]

This story gets more bizarre by the day. As reported here last month, stem cell pioneer Hwang Woo Suk fessed up to ethical lapses in the course of his groundbreaking stem cell research -- specifically, some of the eggs used in his research came from junior researchers in his lab. If not an outright ethical lapse, it was considered "ethically murky" enough (a) for him to lie about it and (b) for his American research partner (Dr. Gerald Schatten of the Univ. of Pittsburgh) to withdraw from the partnership.

Lots of stories followed concerning sloppy data keeping. Then came the bombshell.

[a]n already disgraced scientist lied about all of the stem cell lines he claimed were matched to different patients through cloning, investigating researchers said in a new jolt to the shattered reputation of Hwang Woo-suk.

Thursday’s announcement all but ends the fraud investigation into one of three major cloning breakthroughs claimed by the one-time scientific superstar and national hero. Probes of Hwang’s two other groundbreaking experiments are still under way at Seoul National University where he worked before resigning in disgrace last week.

The latest news was one more disappointment to the scientific world, which had viewed Hwang’s achievements as holding great promise for treating people with a variety of ailments, from spinal cord injuries to Parkinson’s disease. . . .

In the experiment deemed fraudulent, Hwang had claimed in a paper published in May in the journal Science that he had created 11 colonies of human embryonic stem cells genetically matched to specific patients.

An investigative panel at the university reported last week that Hwang had faked the research on nine of the stem cell lines. On Thursday, it confirmed he also fabricated his research for the two remaining cell lines as well.

Before his fall from grace, Hwang enjoyed rock-star status in South Korea. Now two other majore breakthroughs reported out of his lab -- the extraction of stem cells from cloned human embryos and the cloning of a dog -- are also under suspicion and review.

The original article in the June 17, 2005, issue of Science is here. To its credit, the journal has diligently reported on the disturbing reports of ethical lapses and on Dec. 23 published an expression of editorial concern over the possible lapses in connection with the June paper and another paper published out of the Hwang lab on March 12, 2004. [tm]

There's a pretty good government website that collects a lot of data and links on this subject: http://www.pandemicflu.gov. It appears to be a joint effort by HHS, CDC, and the Department of Agriculture. There are good links on these topics:

Monitoring outbreaks (U.S. and international): WHO and European Commission

Many of the goverment resources are a week or more out of date. If you're a subscriber, though, the Wall Street Journal is really on top of this story (see Avian Flu News Tracker). For example, every official web site says there have been two confirmed human deaths in China. This morning, however, Chinese officials reported a third case. The WSJ interactive world map has already been updated to reflect the new number. [tm]

This morning's Bangor Daily News has a "Viewpoints" piece on various states' (e.g., Maine, Minnesota, New Hampshire, Montana) recommendations for protection against the avian flu. Summaries:

Have an emergency supply on hand of food, water, batteries and other necessities for your family to live in isolation for three to five days. Maine calls this an all-hazards kit, and it may be useful in the event of a pandemic.

Families also should develop a plan for who would be contacted through what telephone numbers or e-mail if an outbreak did occur and where the family would seek treatment.

Hand-washing is big in all states, also staying out of the line of sneezes and covering your mouth if you do sneeze.

Some limits on travel to Asian countries that have more serious outbreaks of bird flu is [sic] recommended - for instance, visits to poultry farms there are discouraged.

Health Affairs is the pre-eminent health policy (and often health-law & policy) journal on this side of the Atlantic. Today they published the list of 25 articles that were the most-viewed in past year. To put this in context, #1 was viewed 70,000 times and every article garnered at least 20,000 views:

In this special year-end edition, World Health News reviews the public health issues that shaped 2005.

The Year of Bird FluHuman cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, and Vietnam.

World Bird Flu Risk Is 'Gravest Possible'Reported in the International Herald Tribune on February 24, 2005

"The risk that Asia's outbreak of avian influenza could turn into a deadly global pandemic has increased sharply in recent months, a top international health official warned on Wednesday. 'The world is now in the gravest possible danger of a pandemic,' said the official, Dr. Shigeru Omi, Western Pacific director of the World Health Organization. 'We need to consider urgent and decisive action in radical new ways.' Speaking by telephone from the sidelines of an avian flu conference in Vietnam, Omi said that in recent months it had become clear that strains of avian influenza that emerged last year were now entrenched, endemic, versatile and transmitted through animals showing no symptoms of the disease. If mutated to transmit between humans, he said, the deadly strain of influenza could spread quickly around the world and infect millions."

With stories on hunting bird flu in Cambodia; pursuing a bird flu vaccine in the U.S.; the WHO's 'bird flu strike force' in Switzerland; a $7.1 billion flu plan for the U.S.; and the effects bird flu has had on Thailand, Vietnam, and China.

Among the Highlights from 2005:

The Immediate and Lasting Effects of Hurricane Katrina Los Angeles Times and The Atlanta Journal-Constitution

South Korean Stem Cell Research Suffers Major Setback The New York Times, International Herald Tribune, and The Boston Globe

The Terri Schiavo Case St. Petersburg Times, Florida

Pakistan's Earthquake: The Rescue Effort, the Resulting Homelessness, and the Possibility of 'Donor Fatigue' The Observer (London) and The Christian Science Monitor

Refugee Crisis in Sudan The Washington Post

Toxic Spill in China Left Over 3 Million Without Running Water for Three Days International Herald Tribune, The New York Times, and the Los Angeles Times

AIDS: The Rath Controversy in South Africa, and the WHO's '3x5 Goal' Missed, But Praised The Guardian (London) and The New York Times

Contrary to my post yesterday, it appears that last-minute maneuvering in the Senate temporarily blocked passage of the budget bill, S. 1932, that contains the provision that would require HHS to extend the moratorium on new specialty hospitals. That is at least what the N.Y. Times is reporting today. The glitch, which can be tracked in the Congressional Record's rendition of yesterday's events (not available yesterday), occurred because Senate Democrats took out three relatively insignificant provisions from the budget reconciliation bill. That meant that the House would have to re-vote on the budget bill, and because many House members left town for the holidays after their vote on a couple of appropriations bills on the 19th and 20th, it is unclear when that vote will occur -- possibly not until January, according to the Times' report. Accord, Washington Post. [tm]

Bottom line: "Thus, an individual physician has no obligation to prescribe oseltamivir in response to a patient's request — a position that discourages prescribing of the drug but does not prohibit it. In contrast, the public health perspective clearly suggests that the physician has an obligation not to prescribe oseltamivir — a position that is tantamount to a prohibition against prescribing it. The public health perspective need not always trump the individual perspective, but since both point in the same direction in this instance, the prohibition should prevail." [tm]

S. 1932 passed in the Senate this morning by a vote of 51-50 (with Veep Cheney casting the deciding vote), following the House's passage on Monday (212-206). There are quite a few changes to Medicare and Medicaid tucked away in Conference Report 109-362 (not available on Thomas, but available (presumably for a fee) at the BNA website). One of the more significant developments is the continuation of the moratorium on new specialty hospitals (download specialty_hospitals.pdf). There's also a provision that instructs the Secretary of HHS to conduct a pilot program to evaluate gainsharing. [tm]

Summary: Sections 36 through 43 of Senate Bill 410, enacted during the Seventy-ninth regular session of the Texas Legislature, directly conflict with federal law, namely the Federal Food, Drug, and Cosmetic Act, chapter 9 of title 21 of the United States Code (the "FFDCA"), and specifically sections 381 and 384 thereof. The FFDCA makes it an offense not only to import, but to "cause" the importation of prohibited medications. See 21 U.S.C. § 331 (2000 & Supp. 2003).[1] By "designating" certain Canadian pharmacies, promoting them on its website, and expressly permitting Texas consumers to import prescription drugs that cannot be imported under federal law, the Texas State Board of Pharmacy would violate the Federal Food, Drug, and Cosmetic Act, as will Texas consumers and those Texas pharmacies that take part in such transactions.

The New York Times ran a short but insightful piece today on the exclusion of employer-provided health insurance contributions from employees' taxable income. The amount of the subsidy (in foregone tax collections) is fast approaching $150 billion and is expected to get to $180 billion by 2010. Quoting Harvard economist David Cutler, "If you had $150 billion to play with, you could come very close to universal coverage." Eliminating the tax subsidy, however, would be enormously unpopular with the employed taxpayers who have gotten use to the tax break. And MIT economist Jonathan Gruber sees other problems:

As soon as the tax break was eliminated, company-provided health insurance would be likely to disappear, too. So some mechanism would be needed to pool groups of people and to avoid leaving higher-risk people to face enormous insurance costs. Such a mechanism would probably make health insurance affordable for all. And to make it universal, a mandate would be needed to make people buy it.

This isn't communism. The changes could happen under a public health care system or one that is privately run.

The politics of the issue are such that taking away the tax subsidy would probably be suicidal, despite the impressive bill of particulars against it:

[T]he fiscal incentive isn't helping many of the people who need it most. A report by the Kaiser Family Foundation says two-thirds of the 45.5 million Americans who lacked health insurance in 2004 earned less than twice what the federal government defines as poverty. (For a family of four, the poverty line is about $19,300.) In four of every five cases, the uninsured made less than three times the poverty level.

In addition to going to the wrong people, the subsidy as designed promotes wasteful medical spending, encouraging the wealthy to buy more insurance and to use more health services than they need, according to the president's tax panel. And it may bolster premiums across the board.

Altogether, the health insurance tax break exacerbates America's medical dystopia: while the nation has the highest per-capita spending on health in the world - about $5,400 in 2002 - 18 percent of the population under 65 remains uninsured.

The President's Advisory Panel on Federal Tax Reform's final report (Nov. 1, 2005) addressed the issue and offers a tepid, but politically realistic suggestion (cap the tax benefit at the average cost of family health policyies ($11,500). It would be a start. . . . [tm]

A short commentary in HealthLeaders News ("The Intersection of Intermediate Sanctions and Loss of Tax-Exempt Status for Nonprofits," by J. Leigh Griffith and Donald B. Stewart) reminded me of a proposed rule from the IRS on the always timely issue of intermediate sanctions. Published on Sept. 9, the NPRM identifies the five factors to be taken into account when the IRS is trying to decide whether to revoke the exempt entity's tax-exempt status in addition to imposing intermediate sanctions. As the authors point out, the factors omit any mention of good faith on the part of the entity's managers and emphasize the importance of self-discovery and self-correction (i.e., rectification of the excess-benefit transaction before the IRS brings it to the entity's attention). The transaction may still enjoy a rebuttable presumption of reasonableness if it satisfies the requirements of 26 CFR § 53.4958-6, but good-faith reliance on those factors (including valuations and opinion letters) won't save the entity from loss of its exemption. On the other hand, as the authors point out, the proposed rule introduces the five factors with this clause: "the Commissioner will consider all relevant facts and circumstances, including, but not limited to, the following—," so the good faith of the managers won't necessarily be irrelevant. The comment period for this NPRM closed on Dec. 8. The IRS has indicated this rule is a priority, so we should see a final rule sometime early in 2006. [tm]

Of 74,306 downloads in the SSRN Health Law database, 10 articles account for 21,000 of 'em. Here, in the first of what will be a weekly summary, is the straight dope on the top 10 downloads. Later this weekend, look for a listing of the latest titles posted to the database.

The New York Times has been all over the bioethical implications this story, ever since its piece on Dec. 6, "Ethical Concerns on Face Transplant Grow," by Michael Mason & Lawrence K. Altman (blogged). In the last couple of days, they've published these articles:

in the rush to perform the first face transplant, were corners cut to avoid ethical issues?

is the carnival atmosphere compromising the patient's well-being?

"Among the most disturbing aspects of the debate are conflicting reports from doctors about whether the transplant was the result of two suicide attempts, one successful by the donor, and one failed by the recipient.

"If Ms. Dinoire's disfigurement resulted from an attempted suicide, it would raise questions about her emotional stability and her ability to consent to such a risky operation.

"Reports that the donor committed suicide also have implications for Ms. Dinoire's future, because if true, and if the transplant is successful, it would mean that for the rest of her life, she would see in the mirror the nose, mouth and chin of a woman who herself met a brutal end."

"Critics have already questioned the ethics of a commercial arrangements brokered by Dr. Dubernard ['the flamboyant French doctor and politician in charge of Ms. Dinoire's post-transplant treatment'] in which exclusive rights for photographs and video of the operation were given to Microsoft's Corbis photo agency under an agreement that allows Ms. Dinoire to share in the proceeds from the materials' sale."

Paul Caron at TaxProf Blog has posted some great resources for lawyers who want to teach but need advice on how to break into academe. I'll save you the mouse-click:

Teaching Fellowships for Aspiring Law Professors

For practitioners and others contemplating joining the law professor ranks, many law schools offer wonderful opportunities to transition into the legal academy with one- or two-year fellowships which allow you to enter the AALS Faculty Recruitment Conference (the "meat market") armed with teaching experience and published scholarship under your belt:

Joining the debate are American Enterprise Institute scholar Joseph Antos, who was former assistant director for health and human resources at the Congressional Budget Office, John C. Goodman, founder and president of the National Center for Policy Analysis, and Robert Reischauer, president of the Urban Institute and vice chair of the Medicare Payment Advisory Commission. The debate is moderated by Laurie McGinley, assistant bureau chief at The Wall Street Journal's Washington bureau.

The policy journal Health Affairs covers much the same territory in its Nov./Dec. 2005 issue (series of articles on "Consumerism"). [tm]